Summary
Overview
Work History
Education
Skills
Timeline
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Vangie Porter

Conway,AR

Summary

Knowledgeable and dedicated customer service professional with extensive experience in the Medical Customer Services industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Overview

5
5
years of professional experience

Work History

Provider Services/Claims Specialist

United Healthcare
09.2022 - Current
  • Answer incoming phone calls from health care providers and identify the type of assistance the provider needs (benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
  • Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
  • Deliver information and answer questions in a positive manner to facilitate solid relationships with providers and their staff
  • Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
  • Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g., verify pricing, prior authorizations, applicable benefits)
  • Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents/ certificates tool)
  • Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements
  • Communicate through correspondence with members and providers regarding claim payment or required information, using clear, simple language to ensure understanding
  • Learn and leverage new systems and training resources to help apply claims processes / procedures appropriately (e.g., on – line training classes, coaches / mentors)
  • Meet and maintain the performance goals established for the position in the areas of quality, production and attendance
  • Consistent attendance with ability to meet work schedule including the required training period

Lead Case Investigator

Jennifer Temps (Brunswick County Health Dept)
08.2020 - 06.2022
  • Contacted people exposed to individuals with COVID-19, assessed symptoms and referred for testing.
  • Coordinated with public health and local facilities to support isolation and quarantine of individuals.
  • Reached out to people newly diagnosed with COVID-19 to determine contact histories and potential exposures.
  • Offered basic guidance regarding testing and medical consultation for those exposed to people with COVID-19.
  • Conversation-based investigation to obtain information on close contacts and to assess healthcare and support needs for people diagnosed with COVID-19.
  • Crisis counseling and the ability to confidently refer clients and contacts to further care.
  • Gather information including symptom history, source of illness, list of close contacts, and
    activity history while infectious.
  • Obtain and review patient demographic, location, laboratory, clinical, and risk information
    available in health department surveillance systems or other data systems in order to
    determine investigation priorities, per local protocols.
  • Initiate prompt communication with patients diagnosed with Covid-19 through text, phone
    calls, email, and other communication platforms as necessary.
  • Create Microsoft Excel spreadsheets with accurate information in regards to students in staff
    who are cases/contacts for the County’s Public Schools.
  • Work with schools to determine last date of exposure, close contacts, and return to school
    dates for students.
  • Train new coworkers (1-20 employees at a time) on HIPPA guidelines and how to perform job
    duties.

Insurance Service Professional

Nationwide
11.2019 - 08.2020
  • Consulted with customers to understand desires and suggest best products to meet needs.
  • Gained expert knowledge of insurance (home and auto) operations, market conditions, and
    trends.
  • Helped resolve billing problems by carefully collecting information and developing
    knowledgeable solutions.
  • Satisfied customers by delivering speedy and expert service for all Home and Auto needs.
  • Protected business from unnecessary liability by carefully following security and safety
    standards.
  • Carried out high-quality personal lines insurance work with little oversight.
  • Prevented service delays by effectively using slow periods to get ahead such as reaching out
    to members to market other insurance products, updating accounts, or responding to emails.
  • Continuously met or exceeded daily service quality and performance scores (metrics).

Banking Specialist

Sykes (PNC Bank)
07.2018 - 07.2019
  • Explain bills and transactions with callers.
  • Start fraud, lost, stolen cases.
  • Take payments from customers.
  • Research rewards/checks that customers have received and reissue when necessary.
  • Provided expert service by communicating information to customers and following up on
    promises.
  • Issued refunds, merchandise exchanges, and process adjustments in compliance. with
    company policies.
  • Cross-sold financial services aggressively to customers and followed up with existing account
    holders to offer new products.
  • Responded to customers questions and complaints and documented consumer
    communications.
  • Built strong knowledge of product line to assist customers in selecting products meeting
    highly personal needs.

Education

High School Diploma -

Jack Britt High School
Fayetteville, NC
06.2002

Skills

  • Microsoft Office
  • Policy and Procedure Adherence
  • Operational Processes
  • Provider Enrollment
  • Problem Resolution
  • Inquiry Research
  • Medicaid Application
  • Benefits Verifications
  • Customer Data Confidentiality
  • Medical Claims
  • Coding
  • Call Volume and Quality Metrics

Timeline

Provider Services/Claims Specialist

United Healthcare
09.2022 - Current

Lead Case Investigator

Jennifer Temps (Brunswick County Health Dept)
08.2020 - 06.2022

Insurance Service Professional

Nationwide
11.2019 - 08.2020

Banking Specialist

Sykes (PNC Bank)
07.2018 - 07.2019

High School Diploma -

Jack Britt High School

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Vangie Porter